先天性鼻泪管阻塞泪道探通最佳时机的探讨

目的评估先天性鼻泪管阻塞最佳手术探通时机。方法随机选择眼科门诊2009年1月至2010年9月1057例(1232只眼)先天性鼻泪管阻塞病例。根据年龄分为A组(<1个月),B组(1～3个月),C组(3～6个月),D组(≥6个月)4组进行观察,所有患儿均在局麻下采用泪道冲洗探通针一次性完成泪道探通手术,手术前后使用生理盐水行泪道冲洗1～2 d,术后予妥布霉素滴眼液滴眼,对于术后泪道不通患儿手术1周复行泪道再次探通,2次探通失败者手术后1个月后再行泪道探通术。治愈标准为无溢泪,无分泌物,泪道冲洗通畅。术后仍然流泪,伴分泌物,泪道冲洗不畅为无效。结果 A组、B组、C组、D组1次治愈率分别为100%、93.3%、82.6%、66.7%,4组比较,患儿年龄越小,手术探通治愈率越高,差异有统计学意义(P<0.01)。结论先天性鼻泪管阻塞,年龄越小手术治愈率越高,出生后3个月内为最佳探通治疗时机。     

先天性鼻泪管阻塞伴泪小管阻塞的泪道探通术

目的探讨先天性鼻泪管阻塞合并泪小管阻塞的患儿泪道探通术的效果。方法此病患儿27例（29眼）作为研究组,单纯鼻泪管阻塞23例（30眼）作为对照组。两组均行常规的泪道探通术,应用荧光染料消失试验（FDDT）及泪道冲洗方法,观察治疗效果。结果研究组中合并下泪小管阻塞13例（14眼）,合并上泪小管阻塞者14例（15眼）,成功疏通鼻泪管阻塞26眼,治愈率89．7％;对照组30眼治愈27眼,（治愈率90．0％）,两组之间比较差异无统计学意义,χ2=0．002,P=0．965。成功疏通泪小管者在29眼中仅有11眼,占37．9％。术后FDDT比较,伴有泪小管阻塞组FD—DT0级小于对照组,FDDT1-2级大于对照组,χ2=7．096,P=0．029。鼻泪管探通成功但泪小管探通失败,仅存单个正常泪小管的17眼,仅存的上或下泪小管一部分能够起到有效的引流泪液的功能（上泪小管阻塞FDDT0级4眼,FDDT1级6眼,FDDT2级1眼,下泪小管阻塞FDDT0级1眼,FDDT1级3眼,FDDT2级2眼）。结论先天性鼻泪管阻塞伴泪小管阻塞的患儿,只要存在一个正常泪小管,应用泪道探通术解除鼻泪管阻塞的前提下,患儿溢泪症状较术前均有明显改善,单纯鼻泪管阻塞患儿术后泪液引流作用要好于合并泪小管阻塞者,上或下泪小管均可能起到有效的引流泪液的功能。     

早期泪道探通术治疗先天性鼻泪管阻塞的疗效观察

目的 探讨先天性鼻泪管阻塞(congenital nasolacrimal duct obstruction,CNLDO)的最佳治疗时机,阻塞部位的不同对探通术成功率的影响,以及重复探通术的成功率.方法 对804例(976只眼)1～48个月CNLDO患儿行表面麻醉下泪道探通术,按不同年龄组、不同阻塞部位和重复探通术的疗效进行回顾性分析.结果 经过治疗治愈958只眼,总治愈率为98.2%.不同年龄组探通成功率差异有统计学意义(x2=163.9,P<0.005),其中1～3个月婴儿的成功率为98.5%,高于其他年龄组.66只眼接受二、三次探通术,主要是鼻泪管多处阻塞者,占84.8%.一次探通的治愈率与二、三次探通的治愈率差异有统计学意义(x2=186.0,P<0.005);二次探通与三次探通比较,差异无统计学意义(x2=0.18,P>0.025).结论 CNLDO患儿选择早期泪道探通的最佳治疗时机是1～3个月,鼻泪管多处阻塞患儿重复探通率高,2～3次探通不成功者应尽早采用其他方法进行治疗.     

基础麻醉下泪道探通治疗先天性泪道阻塞

目的 探讨先天性鼻泪管阻塞泪道探通的时机以及基础麻醉下泪道探通的安全性和有效性.方法 回顾性分析先天性鼻泪管阻塞泪道探通术1018例（1070眼）.根据年龄分为6～8月龄,9 ～12月龄和13 ～18月龄3组.其中门诊患儿常规局麻下探通,住院患儿基础麻醉下探通.分析泪道探通效果和并发症发生情况.结果 随访3月后统计：6 ～8月龄组398眼,386眼有效,有效率96.98％;9～ 12月龄组295眼,283眼有效,有效率95.93％;13 ～18月龄组377眼,362眼有效,有效率96.02％,3组间有效率两两比较差异无统计学意义（P＞0.05）.表面麻醉组有效率96.00％,基础麻醉组有效率96.73％,两组间有效率差异无统计学意义（χ2=0.4064,P=0.5238）.但大月龄组（13 ～ 18月龄组）基础麻醉有效率优于局麻者,两者间差异有统计学意义（χ2=4.457,P=0.0348）.并发症：局麻组发生率11.09％,基础麻醉组发生率2.31％,两组之间有统计学意义（χ2 =32.437,P＜0.0001）.结论 基础麻醉下泪道探通并发症少,大月龄（＞12月）患儿有效率高.     

空心泪道探针治疗先天性鼻泪管阻塞

我科自１９９２年１月至１９９６年１２月，共收治了１６５例（其中双眼１２例）、共１７７眼的先天性鼻泪管阻的患儿，其中男９７例，女６８例。右眼８５眼，左眼９２眼。年龄最小１８天，最大４岁。其中１个月以下３例３眼，１～３个月１００例１０８眼（占全部病例的６...     

泪道探通联合眼膏灌注治疗先天性鼻泪管阻塞

目的评价对患先天性鼻泪管阻塞的1岁内婴儿施行泪道探通术联合泪道内灌注氧氟沙星眼膏的临床效果。方法因持续性泪溢、泪道冲洗不通,经泪囊区局部按摩无效而被确诊为先天性鼻泪管阻塞的1岁内婴儿60例(67眼),在局麻下施行泪道探通术,并注入泪道以甲基纤维素为赋形剂的氧氟沙星眼膏,术后点滴氧氟沙星眼水1wk。分别于术后3,7d进行泪道冲洗,随访3mo,观察其临床症状的改善情况。结果所有60例(67眼,100%)通过1～3次的治疗均获临床治愈。其中,1次治愈64眼,治愈率95.5%(64/67);2例(2眼)在首次术后3d因冲洗泪道不通而再次手术后获治愈(3%,2/67);1例1眼)则连续进行了3次手术方获治愈(1.5%,1/67)。无1例造成假道,唯一常见的并发症是在9例(10眼,14.9%)术后鼻腔分泌物中见少许血染。结论对不满1岁的婴儿在局麻下施行鼻泪管探通术联合氧氟沙星眼膏灌注治疗其先天性鼻泪管阻塞是十分安全、简捷而有效的方法。     

先天性鼻泪管阻塞探通手术的护理体会

目的　探讨先天性鼻泪管阻塞探通手术的方法和护理。方法　 5 8例 (66眼 )中 ,男 3 4例 (3 8眼 ) ;女 2 4例 (2 8眼 ) ,年龄 5 0天～ 2岁 ,平均 (1.1± 0 .5 )岁。手术方法 :表麻后 ,扩张下泪点 ,用冲洗式探针由下泪点进针行探通术 ,至鼻泪管下端阻塞处刺破隔膜进入鼻腔。结果　 66眼中治愈 63眼 ,治愈率 95 .45 %。结论　先天性鼻泪管阻塞合并泪囊炎采用冲洗式泪道探通术是一种简单有效的治疗方法。     

两种泪道探通冲洗术治疗先天性鼻泪管阻塞的疗效比较

目的:比较改良的冲洗式泪道探通术与泪道探通冲洗一体式治疗先天性鼻泪管阻塞的治疗效果。方法:选取2008-07/2012-09在我院门诊就诊的252例273眼先天性鼻泪管阻塞的患儿,作为本次的观察对象;其中140例156眼行改良的冲洗式泪道探通,112例117眼行泪道探通冲洗一体式治疗,比较两种方法的治疗效果,并随访1wk～1mo。结果:改良冲洗式泪道探通术一次性探通成功152眼,术后随访有2眼再次阻塞;泪道探通冲洗一体式一次性探通成功107眼,术后随访有8眼再次阻塞;两组比较差异明显具有统计学意义(P<0.05)。结论:改良的冲洗式泪道探通术对先天性鼻泪管阻塞的治疗效果明显优于泪道探通冲洗一体式。     

泪道探针留置术对先天性复杂性鼻泪管阻塞治疗的临床评价

目的评价泪道探针留置术在先天性复杂性鼻泪管阻塞治疗中的临床价值。方法对276例(295只眼)出生1～12个月先天性复杂性鼻泪管阻塞患儿采用泪道探针留置术进行治疗,观察不同年龄组、不同阻塞性质的一次性治愈率以及不同次数探针留置术的治愈率。结果本研究中295只眼接受泪道探针留置术进行治疗,一次性治愈259只眼,其一次性治愈率为87.7%,其中≤3个月组的一次性治愈率为95%,比～6个月组87.5%和≤12个月组74.2%高(P<0.05),而鼻泪管膜性阻塞的治愈率比鼻泪管骨性阻塞的治愈率高(P<0.05);并且,不同次数泪道探针留置术之间的治愈率亦有着显著性差异(P<0.05)。结论泪道探针留置术对先天性复杂性鼻泪管阻塞的治疗有着较好的疗效而且宜早期采用;并且该方法也可以作为基层医院治疗先天性复杂性鼻泪管阻塞一种较好的治疗方法。     

新生儿泪囊炎泪道探通时机评估

目的评估新生儿泪囊炎最佳手术探通时机,探讨手术成功的相关因素。方法随机选择眼科门诊2004年4月至2006年2月2448例2～60个月新生儿泪囊炎病例。根据儿童年龄分为2m～4m,5m～12m,13m～60m三组分别观察。对保守治疗2周无效的患儿采用一体式泪道冲洗探通针一次性完成泪道探通手术,手术前后连续使用妥布霉素,生理盐水,氟美松行泪道冲洗3d-5d,对于术后泪道不通患儿手术后1w复行泪道再次探通,二次探通失败者手术后1m后再行泪道探通术。治愈标准为无溢泪,无分泌物,泪道冲洗通畅。术后仍然流泪,伴分泌物,泪道冲洗不畅为无效。结果2个月～4个月组治愈率（98.44%）,5个月～12个月组治愈率（96.47%）,13个月～60个月组治愈率（90.56%）3组比较,患儿年龄越小,手术探通治愈率越高,差异有统计学意义（P〈0.01）;其中2个月～4个月组1次探通成功率（3.02%）;5个月～12个月组一次探通成功率（6.42%）;13个月～60个月组一次探通成功率（9.12%）;3个年龄组相比,随着年龄增加,多次探通率明显增加,具有统计学意义（P〈0.05）。结论新生儿泪囊炎,年龄越小手术治愈率越高,2周以上保守治疗无效者,应该早期行泪道探通手术。手术前后采用抗生素和激素连续冲洗泪道及采用改良新款一体式冲洗探通针对于手术的成功至关重要。     

Clinical outcomes of initial and repeated nasolacrimal duct office-based probing for congenital nasolacrimal duct obstruction

Purpose

To characterize the outcomes of initial and repeated office-based probing as a primary treatment for congenital nasolacrimal duct obstruction (CNLDO) in children.

Methods

The medical records of patients who underwent nasolacrimal duct office-based probing for CNLDO between March 2004 and January 2008 were reviewed retrospectively. Nasolacrimal duct probing was performed on 244 eyes from 229 consecutive patients with CNLDO. Patients who were refractory to the first probing underwent a second probing 4 to 8 weeks later.

Results

Based on exclusion criteria, 244 eyes from 229 patients (117 males and 112 females), aged 6 to 71 months (mean, 12.4 ± 8.36) were included. The success rate of the initial probing was 80% (196 of 244) for all patients, 82% (111 of 136) in the 6 to 12 month age group, 79% (64 of 81) in the 13 to 18 months age group, and 78% (21 of 27) among individuals older than 19 months (p = 0.868, Pearson chi-square test). The success rate of the second probing was 61% (25 of 41) for all patients, 74% (17 of 23) in the 6 to 12 months age group, 58% (7 of 12) in the 13 to 18 months age group, and 17% (1 of 6) among individuals older than 19 months (p = 0.043, Fisher''s exact test).

Conclusions

While the success rate of initial nasolacrimal duct probing is not affected by age, the rate of success rate with a second probing was significantly lower in patients older than 19 months. Based on the results, authors recommend further surgical interventions, such as silicone tube intubation or balloon dacryocystoplasty, instead of repeated office probing for patients older than 19 months, if an initial office probing has failed.     

Outcome of late probing for congenital nasolacrimal duct obstruction in Singapore children

Objective: To evaluate the outcome of late probing in a mixed Asian children population with congenital nasolacrimal duct obstruction (CNLDO) and whether probing was associated with an increased risk of infection. Method: A retrospective clinical study was conducted. A clinical diagnosis of CNLDO was defined in an infant who presented with a history of tearing and/or eye discharge up to 1 year of age with no other accompanying ocular pathology. All patients with a presumed diagnosis of CNLDO who had probing after 12 months of age were included in our study. Prior to probing, most patients had a trial of conservative treatment with massage and/or topical antibiotics. Intra-operative patency of probing was determined when metal to metal contact of the probe and forceps was achieved and/or when fluorescein dye was recovered from the nose after syringing. Successful probing was defined as a resolution of symptoms within 1 month after probing. Results: Seventeen patients involving 19eyes fulfilled our inclusion criteria for this study. Fourteen (82%) infants were Chinese, two Malays (12%) and the remaining one Indian (6%). There were 10 males(59%) and 7 females(41%) and the mean age at probing was 2.2 years(range, 14 months to 5years 6 months). The subjects were followed-up post-operatively for a mean duration of 21.2 months (range, 2 months to 8years). Successful probing in our series was 89.5% (17/19 eyes). Of the two eyes with persistent tearing, one resolved with massage about 9 months after the unsuccessful probing; the other was referred to the oculoplastic service for further management. Conclusion: Late probing after 13 months old appears to be an effective approach in the management of CNLDO in Asian infants. This revised version was published online in August 2006 with corrections to the Cover Date.     

鼻泪管探通术治疗先天性鼻泪管阻塞的疗效研究

目的：研究探通术与灌溉对儿童先天性鼻泪管阻塞(congenital nasolacrimal duct obstruction, CNDO)的成功率及相关因素。

方法：从2005/2011年,患有CNDO的儿童235例261眼行鼻泪管探通术。患者按年龄分为3组：组1,131眼为12～24月龄; 组2,82眼为>24～48月龄; 组3,48眼为>48～120月龄。在全身麻醉下进行上、下泪小点探通术。术后1d; 1,2wk; 1,3mo进行随访。通过Mann Whitney U检验和卡方检验分析手术成功率与年龄的相关性。

结果：儿童235例(女性122例,男性113例)的平均年龄为27.6±10.7(12～120)mo。3组患儿一次探通术后的成功率分别为90.1%、85.4%和47.6%,并且组1 、组2成功率显著高于组3(P<0.05)。患儿53例(20.3%)再次行探通术,3组的成功率分别为：61.5%、58.3% 和25.0%。

结论：鼻泪管探通术是治疗CNDO的有效方法,特别是对于小于2岁的患儿。手术成功率随着年龄增加而降低,但是上下泪小管二次探通术可以提高术后效果。     

鼻泪管探通术治疗先天性鼻泪管阻塞的疗效观察

目的:研究探通术与灌溉对儿童先天性鼻泪管阻塞(congenital nasolacrimal duct obstruction,CNDO)的成功率及相关因素。方法:从2005/2011,患有CNDO的儿童235例261眼行鼻泪管探通术。患者按年龄分为3组:组1,131眼为12～24月龄;组2,82眼为24～48月龄;组3,48眼为48～120月龄。在全身麻醉下进行上、下泪小点探通术。术后1d;1、2wk;1、3mo进行随访。通过Mann Whitney U检验和卡方检验分析手术成功率与年龄的相关性。结果:儿童235例(女性122例,男性113例)的平均年龄为27.6±10.7(12～120)mo。3组患儿一次探通术后的成功率分别为90.1%、85.4%和47.6%,并且组1、组2成功率显著高于组3(P<0.05)。患儿53例(20.3%)再次行探通术,3组的成功率分别为:61.5%、58.3%和25.0%。结论:鼻泪管探通术是治疗CNDO的有效方法,特别是对于小于2岁的患儿。手术成功率随着年龄增加而降低,但是上下泪小管二次探通术可以提高术后效果。     

Bicanalicular versus monocanalicular intubation after failed probing in congenital nasolacrimal duct obstruction

AIM: To investigate the clinical outcomes of different intubation techniques in the cases of failed primary probing. METHODS: This retrospective study was performed on 338 patients with the diagnosis of congenital nasolacrimal duct obstruction with age 1-4y that had failed primary probing. Intubation was performed under light sedation in operating room and the stent was left 3mo in place. Clinical outcome was investigated 3mo after tube removal. RESULTS: Bicanalicular intubation method had higher complete and relative success rates compared to monocanalicular intubation (P=0.00). In addition, Monoka intubation had better outcomes compared to Masterka technique (P=0.046). No difference was found between genders but the higher the age, the better the outcomes with bicanalicular technique rather than monocanalicular. CONCLUSION: Overall success rate of bicanalicular intubation is superior to monocanalicular technique especially in older ages. Also, based upon our clinical outcomes, Masterka intubation is not recommended in cases of failed probing.     

先天性鼻汨管阻塞的临床治疗

目的探讨先天性鼻泪管阻塞的不同治疗方法和时机。方法回顾分析了735例837眼在复旦大学附属儿科医院诊断为先天性鼻泪管阻塞的患儿,平均首诊年龄4.5个月。根据首诊年龄依次采用保守治疗、加压泪道冲洗和泪道探通法。随访3～16个月,平均6.4个月,以溢泪症状完全消失作为治愈指标。结果保守治疗法治疗837眼,治愈123眼,治愈率14.7;加压泪道冲洗法治疗714眼,治愈181眼,治愈率25.4;泪道探通法治疗533眼,治愈518眼,治愈率97.2.早期探通(≤6个月龄组)一次成功率为87.7;后期探通(>6个月龄组)一次成功率为56.6.结论泪道探通法治疗先天性鼻泪管阻塞安全有效,最佳干预时机为4～6个月龄。     

婴幼儿先天性鼻泪管阻塞的治疗探讨

目的：探讨不同年龄阶段的先天性鼻泪管阻塞的婴幼儿,在不同时期采取不同的治疗方法。 方法：将87例102眼患儿分成三个不同的年龄段组：第一组：25天龄~3月龄21例26眼;第二组：〉3~7月龄31例36眼;第三组：〉7~24月龄35例40眼。对第一组实行泪囊鼻泪管按摩＋滴眼液治疗;对第二组进行泪道加压冲洗治疗;对第三组施行鼻泪管探通术治疗。 结果：第一组患儿经泪囊鼻泪管按摩＋滴妥布霉素眼液治疗通畅者12眼,治愈率为46.2%;第二组患儿经泪道加压冲洗治疗通畅者33眼,治愈率为91.7%;第三组患儿经鼻泪管探通术治疗通畅者36眼,治愈率为90.0%。第二组和第三组效果明显优于第一组（χ2=15.71,P〈0.01;χ2=15.27,P〈0.01）;第二组和第三组治疗效果无明显差异（χ2=0.02,P〉0.05）。 结论：婴幼儿先天性鼻泪管阻塞应该区分年龄阶段,采取不同的治疗方法,才能获得较好的治疗效果,而泪道加压冲洗是治疗婴幼儿先天性鼻泪管阻塞的首选方式。     

Efficacy of probing in the treatment of congenital nasolacrimal duct obstruction in three age groups

AIM: To compare the success rates of probing for the treatment of congenital nasolacrimal duct obstruction in children divided into three age groups. METHODS: One hundred and eighty children with uncomplicated congenital nasolacrimal duct obstruction underwent probing in Eye Hospital of Liaquat University of Medical and Health Sciences Hyderabad, Sindh, Pakistan from March 2005 to January 2008. The children were divided into three groups: Group I (aged 4-6 months), Group II (aged 7-12 months) and Group III (aged 13-24 months). Success was defined as complete resolution of signs and symptoms. The chi-square test was used to analyze the results. RESULTS: The success rate was 100.0% in Group I, 88.5% in Group II and 82.3% in Group III. The overall cure rate for the entire study was 90.7%. CONCLUSION: The efficacy of probing decreases with the increasing age. However, when probing is done within six months of age, it is highly effective and results in complete resolution of symptoms.